Endoscopic treatment of pouch inlet and afferent limb strictures: stricturotomy vs. balloon dilation.

BACKGROUND: Strictures are common complications after ileal pouch surgery. The aim of this study is to evaluate the efficacy and safety of endoscopic stricturotomy vs. endoscopic balloon dilation (EBD) in the treatment of pouch inlet strictures. METHODS: All consecutive ulcerative colitis patients with the diagnosis of pouch inlet or afferent limb strictures treated in our Interventional Inflammatory Bowel Disease Unit (i-IBD) from 2008 to 2017 were extracted. The primary outcomes were surgery-free survival and post-procedural complications. RESULTS: A total of 200 eligible patients were included in this study, with 40 (20.0%) patients treated with endoscopic stricturotomy and 160 (80.0%) patients treated with EBD. Symptom improvement was recorded in 11 (42.3%) patients treated with endoscopic stricturotomy and 16 (13.2%) treated with EBD. Subsequent surgery rate was comparable between the two groups (9 [22.5%] vs. 33 [20.6%], P = 0.80) during a median follow-up of 0.6 years (interquartile range [IQR] 0.4-0.8) vs. 3.6 years (IQR 1.1-6.2) in patients receiving endoscopic stricturotomy and EBD, respectively. The overall surgery-free survival seems to be comparable as well (P = 0.12). None of the patients in the stricturotomy group developed pouch failure, while 9 patients (5.6%) had pouch failure in the balloon dilation group (P = 0.17). Procedural bleeding was seen in three occasions (4.7% per procedure) in patients receiving endoscopic stricturotomy and perforation was seen in three occasions (0.8% per procedure) in patients receiving EBD (P = 0.02). In multivariable analysis, an increased length of the stricture (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.0-1.8) and concurrent pouchitis (HR 2.5, 95% CI 1.0-5.7) were found to be risk factors for the requirement of surgery. CONCLUSION: Endoscopic stricturotomy and EBD were both effective in treating patients with pouch inlet or afferent limb strictures, EBD had a higher perforation risk while endoscopic stricturotomy had a higher bleeding risk.

Early-life experience alters response of developing brain to seizures.

Prolonged seizures during childhood are associated with behavior problems, memory impairment and school failure. No effective treatment currently exists after seizures to mitigate neuronal injury and long-term neurological sequelae for children with epilepsy. We studied the therapeutic efficacy of early-life environment on seizure-induced behavioral deficits, neuronal injury and the inflammatory reaction using the kainic acid (KA) seizure model. Two rearing conditions, maternal separation for 3 h daily versus maternal care in an enriched environment, were followed by single housing for the former (Deprived) and group housing in an enriched environment for the latter (Enriched). To examine the influence of differential rearing on the behavioral effects of early-life seizures, KA was injected on P21. On P28, marked reduction in exploratory behavior was noted after seizures only in the Deprived group. To investigate seizure-induced hippocampal injury, a separate group of rats were injected with KA on P35 since consistent seizure-induced neuronal injury is observed only in mature rats. Brains of rats sacrificed on P37 displayed a significant reduction in DNA fragmentation and microglial activation in Enriched compared to Deprived animals. Our results suggest that a nurturing early environment can enhance the ability of the developing brain to recover from seizures and provide a buffer against their damaging effects. While the nurturing environment was neuroprotective, the combination of deprived rearing and the insult of early-life seizures resulted in significant behavioral deficits, an increase in neuronal injury and activation of microglia in young rats.

Inhibition of return for the discrimination of faces.

When a target appears unpredictably in the same rather than a different location relative to a preceding onset cue, reaction times (RTs) of participants tasked with responding to the target are slowed. This pattern of results, referred to as inhibition of return (IOR), is believed to reflect the operation of a mechanism that prevents perseverative search of nontarget locations. On the grounds that an evolved mechanism might be sensitive to social stimuli, Taylor and Therrien (2005) examined IOR for localization responses under conditions in which cues and targets could be intact face configurations or nonface configurations; contrary to their predictions, there was no influence of cue or target configuration on the magnitude of IOR, indicating that the mere occurrence of task-irrelevant face and nonface stimuli does not alter IOR. In the present study, we further examined this issue in a task that required a face/nonface target discrimination. When target configuration was thereby made task relevant, we found that IOR differed for face and nonface targets in terms of magnitude (when a single cue-target stimulus onset asynchrony was employed) and time course. We suggest that the RT delay associated with IOR may enable additional processing time and/or response selection when a task-relevant face is presented at the cued location.